Is Surgical Staging Necessary for Patients with Low-risk Endometrial Cancer? A Retrospective Clinical Analysis


Purpose: The aim of this study was to compare the tumor-free and overall survival rates between patientswith low-risk endometrial cancer who underwent surgical staging and those who did not undergo surgicalstaging. Materials and
Methods: Data, including demographic characteristics, grade of the tumor, myometrialinvasion, cervical involvement, peritoneal washing, lymph node involvement, lymphovascular space invasion,postoperative complication, adjuvant treatment, cancer recurrence, and tumor-free and overall survival rates, forpatients with low-risk endometrioid endometrial cancer who were treated surgically with and without pelvic andparaaortic lymph node dissection (LND) were analyzed retrospectively. The patients diagnosed with endometrioidendometrial cancer including the following criteria were considered low-risk: 1) a grade 1 (G1) or grade 2 (G2)endometrioid histology; 2) myometrial invasion of <50% upon magnetic resonance imaging (MRI); 3) no stromalglandular or stromal invasion upon MRI; and 4) no evidence of intra-abdominal metastasis. Then the patientsat low-risk were divided into two groups; group 1 (n=117): patients treated surgically with pelvic and paraaorticLND and group 2 (n=170): patients treated surgically without pelvic and paraaortic LND.
Results: There wasno statistical significance when the groups were compared in terms of lymphovascular space invasion, cervicalinvolvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher ingroup 2 (p<0.005). The number of patients with positive pelvic nodes and the number of metastatic pelvic nodeswere significantly higher in the group with positive LVI than in the group without LVI (p<0.005). No statisticallysignificant differences were detected between the groups in terms of tumor-free survival (p=0.981) and overallsurvival (p=0.166).
Conclusions: Total hysterectomy with bilateral salpingo-oophorectomy and stage-adaptedpostoperative adjuvant therapy without pelvic and/or paraaortic lymphadenectomy may be safe and efficienttreatments for low-risk endometrial cancer.